November is National Diabetes Awareness Month

November is American Diabetes Awareness Month. According to the American Diabetes Association, “nearly 24 million children and adults
(7.8% of the population) in the United States (are) living with
diabetes, and an additional 57 million Americans (are) at risk.”
There are two major types of diabetes. Type I, also known as insulin dependent diabetes, occurs when the body does not produce insulin.
This type only affects 5-10% of the American population and results
from an auto-immune destruction of the insulin-producing cells in the pancreas. Type II diabetes, also known as insulin-independent diabetes or insulin-resistant diabetes, is a condition in which the body produces insulin but fails to use it properly. When the body becomes insensitive to the effects of insulin, a dangerous accumulation of sugar occurs in the blood leading to damage to small blood vessels and to organ dysfunction. Keeping a tighter lid on the
cookie jar may be a good start to reducing sugar consumption and the risk of developing diabetes.


What exactly is Diabetes?

When a person has diabetes it means that his or her body is not properly absorbing glucose, a type of simple sugar. Our cells need and utilize glucose for energy. Over time, however, too much glucose circulating in the blood can be toxic and lead to problems such as kidney failure, blindness, and loss of sensation. An easy way to understand the insulin-glucose connection is to think about the role of our mailman. The mailman carries and delivers our mail to our house every day, rain or shine. Insulin performs a role similar tothe mailman's because it carries and delivers glucose into our cells. When a person develops Type II diabetes, it is as if the mailman
is on strike and refuses to deliver the mail until more suitable conditions exist. When this happens, the mail just collects at the post office, we can't pay our bills, and we are left in a
financial crisis! If insulin doesn’t work, glucose accumulates in the blood and the body goes into a state of sugar turmoil. By maintaining a steady insulin-glucose balance, we can avoid these
insulin meltdowns and protect our body from experiencing toxic sugar overload. Choosing complex carbohydrates, eating smaller meals throughout the day, and watching proportion size are steps we can take to keep insulin and glucose in metabolic harmony.

Unfortunately, type II diabetes is not considered an adult disease anymore, and in fact, more and more older children and adolescents are being diagnosed. This is a very disturbing problem and reflects the obesity epidemic in our country. The good news is that eliminating excess weight, especially abdominal fat, decreases the risk of developing insulin resistance and the progression to Type II diabetes. Lifestyle therapies such as losing weight , engaging in
consistent moderate exercise and maintaining a healthy, low-fat diet filled with complex carbohydrates (whole grains and fiber rich foods) will set you on the right path toward good health. This Shabbos try snacking on sliced apples dipped in peanut butter, strawberries
drizzled with coconut flakes, or bananas sprinkled with ground flax seed. Make fruit snacks a fun dessert option by coming up with creative ways of dipping or adding toppings to them (minus chocolate and caramel sauces!). Also, this Shabbos take your children on a brisk
after-dinner/ after-lunch walk. This is a great time not only to lighten up after a full meal, but to provide an intimate time to engage in special parent-child moments. This can become a
unique Shabbos ritual shared and looked forward to each week. Play an active role in disease prevention and you will be providing one of the most important tools your child will carry throughout life – the recipe for good health.

Take a Bite Out of Your Apple Shape!

Being overweight is a very strong risk factor for the development of many chronic diseases such as diabetes, heart disease and certain forms of cancer. Assessment of body weight involves two key measures: body mass index and waist circumference. The body mass index or BMI is a calculation that was developed to determine the amount of body fat based on a person’s height and weight. Once calculated, a person may be defined as underweight if BMI <> 30). (Quickly calculate your BMI at http://www.nhlbisupport.com/bmi/). There are some limitations when calculating one’s BMI. First, athletes and others who have larger muscle mass may have an overestimated BMI because the weight of these individuals is disproportionate to their height due to the increased amount of muscle. The opposite is true of older individuals who have decreased muscle mass. These individuals may have an underestimated BMI and may have more total body fat then calculated. Because the body mass index calculation has its drawbacks, a more important tool in evaluating body weight is measuring the abdominal or waist circumference measurement (WCM). When measuring one’s waist circumference, you are essentially measuring abdominal fat, which is a stronger predictor of developing risk factors for heart disease and diabetes. It seems that the distribution of fat stores, especially abdominal fat, is more important in determining risk factors than the total amount of fat. In fact, it has been documented that individuals who suffer from diabetes or heart disease tend to have “apple-shaped” figures storing excess body fat around the abdomen. To measure your waist circumference, place a measuring tape snugly around your waistline right above your belly button. Waist measurements over 40 inches in men and over 35 inches in women are considered above normal. A cluster of risk factors has shown to promote the risk of developing Diabetes and Heart Disease and of all the risk factors, abdominal obesity has the strongest association with insulin resistance. In fact, the concept of a cluster of metabolic abnormalities, including abdominal obesity, hypertension, impaired fasting glucose, and hyperlipidemia (high blood lipid levels), leading to the development of insulin resistance, diabetes, and heart disease has been understood for the past sixty years and was originally referred to as Syndrome X or the Deadly Quartet. In 1998, the official name, Metabolic Syndrome was coined by the World Health Organization. The Mayo Clinic defines Metabolic Syndrome as “a cluster of conditions that occur together, increasing your risk of heart disease, stroke and diabetes.” In 2002, the American Association of Clinical Endocrinologists (AACE), designed the criteria for diagnosing Metabolic Syndrome involves having three of more of the following components:

Impaired fasting glucose (100 -126 mg/dl) or 2-h post oral glucose (≥ 140 mg/dl)

• Blood pressure ≥ 130/85 mmHg
• Abdominal obesity (waist circumference >102 cm (men) or 88 cm (women)
• HDL-cholesterol <>
• Body mass index ≥ 25 kg/m2
• Other risk factors: family history of type 2 diabetes, hypertension or cardiovascular disease; PCOS, aging, physical inactivity, ethnic susceptibility to type 2 diabetes or cardiovascular disease

The good news is that most of the risk factors are modifiable and by managing your risk through lifestyle therapies, you may reduce the major risk factors for Diabetes and Heart Disease. Lifestyle interventions include weight loss, increased physical activity and healthy eating habits.

http://www.metabolic-syndrome-institute.org/news/2005/2005-05-19-document-view2.php

http://www.americanheart.org/presenter.jhtml?identifier=4756

http://www.thedoctorwillseeyounow.com/articles/nutrition/fatdistribution_1/#1

The Skinny on Fats and Breast Cancer

A considerable amount of research has been linked to high fat diets and the risk of breast cancer. In response to these findings, dietary recommendations have evolved directing women to maintain a “low-fat” diet to help reduce the chances of developing this frightening disease that effects 1 out of every 10 women. Although we have been given explicit instructions to lower fat intake, it is important to understand what is low and which types of fats actually propose the most risk. Generally, to maintain a “low-fat” diet the American Heart Association recommends to eat no more than 25% of total calories as fat, and that less than 1/3 of this twenty-five percent should come from saturated fats. That means based on an average 2000-calorie diet, a woman should not consume more than 500 calories in fat or 56 grams of fat per day. However, only 16 grams or 144 calories of fat can come from the saturated form. For example, one cup of 2% milk contains 3 grams of saturated fat, but substituting low-fat milk to skim milk reduces your saturated fat intake to zero! For the most part, large amounts of saturated fats are found in animal based products such as eggs, milk, cheese, and red meat. Certain vegetable oils also have saturated fats; however, their ratios of saturated fats to the healthier variety of mono or polyunsaturated fats are very different then in animal based counterparts. For instance, take a look at the following table that shows the breakdown of types of fats in different types of foods.

BREAKDOWN OF FATS

Food – 1 tablespoon	Saturated Fat in grams	% Saturated Fat	% Monounsaturated Fat	% Polyunsaturated Fat
Butter	8	70	5	25
Olive Oil	2	14	78	8
Canola Oil	1	7	62	31

Although studies have shown a positive correlation between saturated fats and breast cancer, the consumption of mono and polyunsaturated fats such as oleic acid (a major constituent of olive oil) as well as omega-three fatty acids (found in fish oil) have actually reduced the risk of breast cancer. There are many ways to transition into a low-fat diet and following website gives 10 easy ways to get started.

http://lowfatcooking.about.com/od/lowfatbasics/a/tensteps05.htm.

In addition to lowering saturated fats and increasing the amount of “healthy fats”, there are a couple of “Super Foods” that have a protective effect toward the developing of breast cancer including: walnuts, decaffeinated green tea, fiber, Vitamin D, Folic Acid, and Soy. The following recipe taken from Mark Reinfield’s fantastic new cookbook coauthored with Jennifer Murray titled “Vegan in 30 Minutes” is a perfect example of cancer-protective meal, combining the proper proportion of “healthy fats” with some of the suggested “Superfoods”. The spinach really packs a punch in this salad and provides the fiber (2 grams per serving) and folic acid (58.2 mcg per serving). The walnuts and olive oil provide the proper proportion of healthy fats into your diet.

Warm Spinach Salad

(Serves 4)

8 cups of prewashed spinach, lightly packed

4 Cremini mushrooms

¾ cup thinly sliced red onion

2 Roma tomatoes, thinly sliced into whole circles

1 ½ tablespoon of red wine vinegar

1 teaspoon of agave nectar

1 ½ tablespoons Dijon mustard

2 tablespoons water

½ teaspoon sea salt, or to taste

¼ teaspoon black pepper, or to taste

½ cup chopped walnuts

3 tablespoons of olive oil

1.) Place the spinach in a large mixing bowl with the mushrooms, onion and tomatoes

2.) Place the vinegar, agave nectar, mustard, water, salt, and pepper in a small bowl and whisk well

3.) Place the walnuts in a small sauté pan over medium heat and dry-roast for 2 minutes, stirring frequently. Add the olive oil and cook for 2 minutes, stirring frequently. Add to the bowl with the liquids and mix well. Pour this into the large bowl with the spinach and gently toss well.

Variations: You can sauté the mushrooms before adding to the salad. Add them to the pan after adding the olive oil and cook for 3 minutes, stirring frequently.

Protection By Early Detection

October is National Breast Cancer Awareness Month. Breast cancer is the most common cause of cancer, other than skin cancer, in women in the U.S. In addition to mammography, annual breast exams are one of the most important tools in regard to early cancer detection. All women over age 20 should perform monthly breast self-examinations. The following link from the American Cancer Association contains intructions and demonstrates the proper way to perform a breast self-exam.
http://www.cancer.org/docroot/cri/content/cri_2_6x_how_to_perform_a_breast_self_exam_5.asp

In addition to self-exams, the American Cancer Society (ACS) recommends a baseline mammogram for all women by age 40. Locally, in St. Louis you can get your "mammogram to go" by making an appointment to visit one of Barnes-Jewish Hospital’s Mammography Vans, which brings quality mammography services to women in St. Louis and surrounding areas (Funded mammograms available for those without health insurance).

http://www.barnesjewish.org/cancer/default.asp?NavID=3253

If you live in other parts of the United States, you can perform a search through the American College of Radiology to identify a mammography center closest to you.

http://www.acr.org/accreditation/accreditedFacilitySearch.aspx

Or you can also try calling your local hospital to find out if there are any promotional mammography testing normally offered during this time of the year. Make early detection your best protection for good health and wellness.

SUKKOT HOLIDAY MENU

Like the changing of the leaves, the early fall harvest vegetables such as squash and pumpkin are filled with hues of greens, oranges, reds and yellows. These richly colored vegetables are excellent sources of carotenes, powerful antioxidants that protect against chronic disease. I love to use their beautiful colors and tastes when painting my Sukkot-food palette. Ubiquitous at most supermarkets, squash and pumpkins are not only great for cooking, but you can use ornamental gourds for decorating your Sukkah! With so many meals to entertain including Chol Hamoed and Simchas Torah, try preparing a variety of hearty, vegetable soups served with warm breads. These meals are not only economical, but delicious and nourishing for your family and guests. “And I praised joy, for there is nothing better for man under the sun than to eat and to drink and to be merry, and that will accompany him in his toil the days of his life that God gave him under the sun.” (Koheles 8:15) Chag Sameach!

MENU:

Pomegranate Spritzers
Apple Butternut Squash Soup
Baby Lamb Chops with Rosemary Garlic Dijon Breadcrumbs
Green Beans with Lemony Tahini Sauce
Wild Rice Pilaf with Cranberries, Apricots, and Pumpkin Seeds
Pumpkin Pie with Parve Vanilla Bean Ice Cream
Apple Chamomile Tea with Honey

Keep the Sodium Out of Your Sukkah!

Did you know that the recommended daily allowance (RDA) for salt is 2,400 mg or about 1 teaspoon’s worth? Keeping a watch on your salt intake is one of the most important ways you can control and prevent high blood pressure, also known as hypertension. Hypertension increases your risk of heart disease and stroke and is one of the contributing factors to the hardening of arteries. Try to cut down on salt consumption this holiday season by cooking less with it. Only add salt at the table. That way you can effectively monitor your daily teaspoon allotment. Remember that many foods, especially foods that come prepackaged, contain salt, which needs to be calculated along with any additional salt you use at the table. Enjoy sprinkling your challah with honey rather than salt and enjoy a sweet, unpressured year! Hag Sameach! Daniela Hermelin, M.D. http://www.wellnesstobemd.com